Warren Alpert Medical School of Brown University, Providence, RI.
Keck School of Medicine of the University of Southern California.
J Craniofac Surg. 2023 Jun 1;34(4):1231-1234. doi: 10.1097/SCS.0000000000009266. Epub 2023 Mar 14.
As more centers offer gender-affirming procedures, dissemination of best practices is critical to ensuring quality care. This study is the first to use advanced 3-dimensional visualization software to characterize cranial differences between natal males and females, as they relate to planning for facial gender-affirming operations.
A retrospective analysis was conducted on randomly selected patients with facial computed tomography imaging performed at a single institution between February 2020 and July 2021. Patients with acquired bony deformity on computed tomography or documented history of hormone replacement therapy were excluded. The images were retrieved and analyzed using advanced 3-dimensional visualization software (Vitrea). Independent sample t tests were performed to analyze variation in typically sexually dimorphic facial features between natal males and females.
We identified 50 patients (25 natal males and 25 natal females) who met the inclusion criteria. Ages ranged from 19 to 91. Natal males were found to have significantly greater frontosellar distances (difference between means, SEM: 2.7±1.2; P =0.03) and mandible volumes (difference between means, SEM: 14.0±4.2; P =0.002) than natal females. Statistical analysis revealed no significant differences in gonial angle, chin width, nasofrontal angle, or nasolabial angle between natal males and females.
In this diverse sample of natal males and females, statistical analysis revealed that the sexually dimorphic facial characteristics most relevant to the planning of facial gender-affirming surgery are frontosellar distance and mandible volume. When planning facial gender-affirming surgery, we recommend that these characteristics be considered to achieve optimum results.
随着越来越多的中心提供性别肯定程序，传播最佳实践对于确保高质量的护理至关重要。这项研究首次使用先进的三维可视化软件来描述与面部性别肯定手术规划相关的出生男性和女性之间的颅面差异。
对 2020 年 2 月至 2021 年 7 月在一家机构进行面部计算机断层扫描成像的随机选择患者进行回顾性分析。排除了计算机断层扫描上有获得性骨畸形或有激素替代治疗记录史的患者。使用先进的三维可视化软件（Vitrea）检索和分析图像。采用独立样本 t 检验分析出生男性和女性之间典型性别二态性面部特征的差异。
我们确定了 50 名符合纳入标准的患者（25 名出生男性和 25 名出生女性）。年龄范围为 19 至 91 岁。与出生女性相比，出生男性的额蝶距（均值差，SEM：2.7±1.2；P =0.03）和下颌骨体积（均值差，SEM：14.0±4.2；P =0.002）明显更大。统计分析显示，出生男性和女性的下颌角、下巴宽度、鼻额角或鼻唇角之间无显著差异。
在这个多样化的出生男性和女性样本中，统计分析显示，与面部性别肯定手术规划最相关的性别二态性面部特征是额蝶距和下颌骨体积。在规划面部性别肯定手术时，我们建议考虑这些特征以达到最佳效果。
